Provider Demographics
NPI:1871582429
Name:CONDIE, KARYN JESTER (MD , MPH,, PHD)
Entity type:Individual
Prefix:DR
First Name:KARYN
Middle Name:JESTER
Last Name:CONDIE
Suffix:
Gender:F
Credentials:MD , MPH,, PHD
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Other - Credentials:
Mailing Address - Street 1:1515 TRUEMBER STREET
Mailing Address - Street 2:REID CLINIC - LACKLAND AIR FORCE BASE
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78236
Mailing Address - Country:US
Mailing Address - Phone:210-671-5015
Mailing Address - Fax:
Practice Address - Street 1:1515 TRUEMPER ST
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78236-5583
Practice Address - Country:US
Practice Address - Phone:210-671-5015
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-10-17
Last Update Date:2014-03-07
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
VA0101228770207Q00000X
OK25914207QA0505X
TXN1986207QA0505X, 2083A0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult Medicine
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No2083A0100XAllopathic & Osteopathic PhysiciansPreventive MedicineAerospace Medicine